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LET THE FUN BEGIN!

mothermari — Fri, 27 Nov 2009 23:44:41 +0000

Study: Cost of treating diabetes to triple by 2034 - CNN.com

Mickey — Fri, 27 Nov 2009 20:03:15 +0000

Study: Cost of treating diabetes to triple by 2034 – CNN.com Having dealt

My story #14 - Due dates and post-mortem results

livingintherainbow — Fri, 27 Nov 2009 12:35:13 +0000

Well November is nearly past and it is time for another reflection on what was going on a year ago. I think this will be the last of these “a year ago reflections.” After this there were not too many events of note. Just the long and slow grieving process which is still continuing of course…

…In the months following Abigail’s death we were pretty much in a daze to be honest. A week after the funeral and I was back to work in a very public way heading the annual conference for the charity I work for. The work was easy enough. But having frequent head tilt “how are you” conversations with people was challenging. Some people really wanted to know and could cope with the truth but others just wanted to go through the motions and hear that you were getting there (wherever there is) and that you could quote some vague religious platitude.

It wasn’t long before I found myself referred for more infertility tests picking up from where we had pulled out when we found out we were pregnant with Abigail. Both my wife and I wanted to get as much of this behind us before we cared again. We had had two and a half years of disappointment leading up to Abigail being conceived and we were not looking forward to the monthly rollercoaster of trying to conceive again. So yes in the months that followed I had numerous opportunities to have intimate relations with a cup, go for physical examinations, blood tests, an ultrasound (on me this time!) and the rest. I remember the first time I went to see the urologist consultant, I had to walk through the maternity unit and see lots of pregnant women waiting for their ultrasounds. It was so unfair that here I was going to see if anything could be done to see if we could get pregnant when here were all these women who were already there. If only we could reset and reboot – go back to when we were pregnant and play it again and see if we got a different outcome.

In the weeks following the funeral we knew that the first week of December was going to be especially jarring. We had Abigail’s post-mortem results on 1 December and her due date was 6 December. I booked the week off work and before long, these dates were upon us.

My wife and I discussed the PM results before the day and we both felt that anything less than a 1 in 4 chance of recurrence would not be enough to stop us trying for another baby. 1 in 4 might be enough. We had a strong suspicion that Abigail had died from a genetic condition. Some of her fingers and toes had been fused together and that seemed a strong indicator of a chromosomal cause. Even as I write this now, I hate the idea that some readers might think “ah well in that case she was left than perfect/not normal so perhaps her dying was probably for the best.” Someone said basically that in a card to us once! Let me be as clear as I can. Abigail may not have been perfect – nor are any of us! – but we loved her as if she was. If she had lived we would have loved her with all our hearts no matter what challenges she would have faced.

The day of the post-mortem results came and we dropped our son off with friends and walked in to the hospital. We had done this so many times for scans and now we repeated that well-known routine. We parked the car and had five minutes to spare so we walked along the street outside. We then went into the waiting area and this was the one time I felt the hospital let us down. We were in a maternity waiting area surrounded by posters of babies, mothers with babies, mother’s breastfeeding their babies to “give them the best start in life”. This was also the room where we had had anti-natal classes when we were pregnant with our son.

There was one mother-to-be and grandmother-to-be waiting. They were very chirpy and talking excitedly about their pregnancy. We were not chirpy but very sober. At one point the grandmother-to-be even made a comment about how we seemed very serious. I nearly told them we were there for our daughter’s PM results but restrained myself. Altogether we waited about 25 minutes past our appointment time and that was hard in that room.

Finally we were taken into the consultant’s office. Our doctor, Paul had been great during the pregnancy but by now we were quite on edge. He had a student doctor with him. A girl who seemed about 17 (probably 23). I doubt she had done one of these before. Paul came straight to the point and said that he was sorry for the delay but the formal PM report had not come back to him so he had been getting the results over the phone. Abigail had had triploidy. This was a condition that resulted in a lot of miscarriages but not many babies made it as far as birth. All in all it accounted for about 1 in 50,000 live births. It occurred when a baby had 69 instead of 46 chromosomes. It was always fatal and no baby had lived beyond 10 months with triploidy.

The good news (!) was that it was a fairly random event and was not likely to recur for us. Say 1 in 100. There was no reason we couldn’t try for another baby – other than ongoing infertility problems that is. Ironically the majority of triploidy cases occurred when 2 sperm fertilised one egg. Madness – none of my sperm were good enough to get to the egg but when one finally did a second one did too! Stupid sperm. Grrrrrr.

Here is a final email I sent to all our friends and family who had been receiving updates during Abigail’s short life.

There are two ways to tell you about the PM, the first is medical – what we know and think. We now know that Abigail had a genetic condition called triploidy. This results in quite a lot of early miscarriages but it is very rare to last as long as we did. It only affects about 1 in 50,000 births. It is lethal with most triploidy babies being still born or with an average life expectancy of 10 hours after birth. It is not hereditary – as the doctor puts it we were struck by lightning. This is a relief as otherwise there would have been a chance that [our son] could have faced similar problems in his future. That said we do face an increased risk of this or similar happening to us again of about 1 in 100. This is a lot lot lot better than 1 in 4, but not as good as nothing! Stating the obvious there. So overall not as bad as we feared but not as good as we could have hoped.

The second way to talk about these results is not what we think or know, but how we feel. Abigail was conceived into a fallen broken world as we all were. But, we do not love her one tiny bit less for this. We do not think of her as imperfect in any way more than everyone else alive today including you and me. We certainly don’t want people telling us it was a mercy she died when she did, or that we have been saved from more heartache. If we had had 10 hours with her we would have treasured those 10 hours. We do treasure the limited time and limited contact we had with Abigail – we always will, it has tremendous value to us as her parents. Even though we know now that she was never going to survive we still grieve the life and the potential that she had in our hearts and dreams. We will remember the milestones that never occur even if they could never have been. I share this side of it with you because as our friends and family we want you to understand and be comfortable with the simple fact that at this simple level Abigail remains part of our lives and part of our family. We hope you can be part of this too and feel comfortable talking about this side of things with us. We do not expect or want this to be a morbid thing but a way of valuing the person Abigail was and is.

One final thing, this verse has been helpful to us from Lamentations 3 v32-33

Though he brings grief, he will show compassion,

so great is his unfailing love.

For he does not willingly bring affliction

or grief to the children of men.

We do not expect to understand why this happened to us, but we will accept it. And we know that God is good and faithful.

We had ended up arranging to visit friends for the weekend of Abigail’s due date. This was probably a mistake. We were struggling to function and it was all fairly chaotic at our friend’s house. They had other people staying and four children so the house was quite crowded and we didn’t really have an opportunity to talk meaningfully. In the middle of bedtime routines the Dad of the home said something to the effect that it felt like he had 18 children to put to bed. I came close to saying “lucky you” but again restrained myself. These people were (and are) good friends but we were not in a good place.

At one level Abigail’s due date didn’t have the meaning it might have had. If Abigail had lived she would have been delivered by C-section much earlier than this date. But looking back further to finding out we were pregnant, this was the date we had been told was her due date. Over the entire length of Abigail’s pregnancy this was the date we had expected to be filled with joy. Instead we were just getting stuck into the grieving process and wondering whether we would ever get pregnant again. Not a very acceptable exchange really!

In the run up to Christmas we felt increasingly lonely in our grief. The support that had been so tangible in the first few weeks now faded into normality for others and raging grief for us. People moved on but we did not. There was nothing new for people to say to show their support and we increasingly found it unsatisfying being around people.

We had a few days away with some friends in a holiday park and I remember getting into an argument about gender specific appropriate activities. It got quite heated until I eventually explained that I was arguing from the point of view that Abigail had been a girl and therefore I wanted to imagine her in pink and doing ballet dancing not football lessons. Stupid really.

We then stayed for a weekend with some friends who had driven an 800 mile roundtrip for the Abigail’s funeral and given a massive donation to Abigail’s fund. We had hoped to catch up with them and share where we were at with Abigail. But basically they couldn’t hack any conversation about Abigail at all. Whenever she was mentioned they would immediately change the subject. We hated that weekend more than anything.

But that was compensated by the fact that we then spent an evening with some friends who had suffered three miscarriages and ongoing infertility problems. They were so understanding and happy to talk about Abigail. This has been a valuable lesson to people – how comfortable people are with suffering seems directly related to how much they have themselves sufferred.

For Christmas we have always had a tradition of buying a new decoration for the tree each year. This year we bought a bauble with Abigail’s name on it. This was on the tree this first year and will continue to be part of our Christmas tree for years to come. It was good to be able to recognise her in our family Christmas.

Women's health negotiated away | citizen-times.com | Asheville Citizen-Times

Mickey — Fri, 27 Nov 2009 11:20:41 +0000

Women’s health negotiated away | citizen-times.com | Asheville Citizen-Times Onc

WELCOME TO THE FAMILY!

mothermari — Thu, 26 Nov 2009 11:36:38 +0000

Our son has often referred to our family as the Soprano’s. I, on the other hand, have always referred to them as the Kennedy’s. Regardless each in their own right is a family.

This morning around 2:00 a.m. we were called to aid in a family matter. While following MacGyver home, I was flooded with recollections of several past events, which were equivalent to tonight. Events that occurred years ago so comparable in nature as to tonight’s events, it is eerie.

Thankfully, it was an event that was not serious, it was very comical though a sharp reminder of what family is all about. It was also an introduction of sorts to a new family member. I know she felt bad about calling us at 2:00 a.m. this morning to assist, but she handled the situation correctly. There is one rule that is always followed regardless of any disagreements or spats between the family members, and it is very simple but best summed up by this song by B. Scott and B. Russell.

The road is long
With many a winding turn
That leads us to who knows where
Who knows when
But I’m strong
Strong enough to carry him
He ain’t heavy, he’s my brother

So on we go
His welfare is of my concern
No burden is he to bear
We’ll get there
For I know
He would not encumber me
He ain’t heavy, he’s my brother

If I’m laden at all
I’m laden with sadness
That everyone’s heart
Isn’t filled with the gladness
Of love for one another

It’s a long, long road
From which there is no return
While we’re on the way to there
Why not share
And the load
Doesn’t weigh me down at all
He ain’t heavy, he’s my brother

He’s my brother
He ain’t heavy, he’s my brother…

Welcome to the FAMILY!
Happy Thanksgiving!

UPDATE: Details on "the plan" for Real Health Reform

Obi Jo — Thu, 26 Nov 2009 04:51:05 +0000

Here is a continuing update detailing, in greater depth, various points of “The Plan” designed to address the reasoning behind these ideas and the objections some have voiced.

(1) All persons must have health insurance from the private sector or government sponsored plans.

Many have objected to this as a violation of personal choice and freedom. However, I would suggest that it is a dereliction of civic responsibility (if such a thing still exists in America) to force others (fellow citizens, doctors, hospitals, insurers, government - i.e. taxpayers) to pick up the tab for you when you become very sick or injured (as you WILL at some point in this life). By mandating coverage with penalties, just as we do for auto insurance, we put personal responsibility back in the equation. It has been far too long since that was the case as the government in particular, along with big labor and big business to varying degrees, have sought to remove responsibility from the individual and to displace it to some other entity.

(2) Proof of insurance would be required to get any type of license, enroll in school, apply for job, yearly confirmation will be required, etc. just as with automobile insurance.

Like all mandates, those without teeth fail. Therefore, there needs to be a “stick” which can be applied in the course of daily life, as opposed to a medical emergency (when no person will be denied care). The suggestion here is that all persons would be effected by these type of requirements and therefore the need to make sure that they have health coverage would be a strong driver for compliance.

(3) Fine of $1,000 if presenting to Doctor, Hospital, etc., for service without insurance, and must pay all expenses for services.

This item is potentially more problematic, but only in the case of a TRUE emergency. It would also require the cooperation of health care workers, doctors, offices, hospitals, clinics, etc. to report offenders. This is not necessarily the ideal scenario, however, along with point number 2, it forms the basis of a credible strategy to ensure compliance with point number 1, which, after all, is the real goal.

(4) The truly financially disadvantaged should be folded into the current Medicaid system with revisions; in that they should pay needs based premiums. As such, Medicaid, Medicare, disability, workers compensation, Government employees, Veterans, Retirement and children’s programs would not be significantly changed.

Here we get to one of the major issues, coverage (and access) for those without means to acquire private coverage in the marketplace. There is much to debate about each of the programs mentioned here. Many things can and should be changed about how these programs work. However, if we try to fix ALL issues in the system at once, the most major items of reform will not occur. Therefore, we MUST focus on what is achievable and provides the most benefit within the framework of our currently established free market/government based system. Expansion of these current forms of tax payer subsidized coverage should continue for the near term. Over time, some of these programs can be merged, rearranged or even eliminated without affecting the base of coverage provided.

(5) All company-sponsored programs would be phased out over three years (better than a tax break).

This will strike some as a major politically incorrect proposal. However, if we are to restore personal responsibility back to the system we must do so by removing the need for businesses, which are clearly not in the health insurance business, from it. Business should not be in the health business, but in business. The morass created by having to have benefit coordinators (who spend most of their time on health insurance matters) instead of focused on traditional benefits (retirement, vacation, leave, etc., etc.) is inefficient and costly. Elimination of the need for businesses to carry these costs will result in markedly reduced overhead, which is even better than a tax break to expand their current coverage systems as some have suggested.

(6) Minimum wage increased by $2.00 per hour so low income workers would have no excuse to offer for not having coverage.

Again, there will be resistance in many quarters to this proposal. As we well know, the minimum wage is in the process of being increased as we speak ($6.55 effective July 24, 2008 and then again rising to $7.25 per hour effective July 24, 2009). However, a further increase as suggested beyond this is a better format than asking businesses of all sizes to carry the full load for providing health insurance, which should be a personal responsibility. For a full time worker, this $2 increase translates to $4,160 per year ($2 x 2080 hours). That is more than sufficient for workers to purchase their own health care coverage within the context of the full plan as outlined here.

(7) Private health insurance should be re-structured to function as a regulated utility. Their rate structure should be only that needed to operate (process payments, review claims etc) plus a set profit of not more than 8-10%. Rates to be set nationally not state by state, or group by group.

Another very controversial approach. This site favors open markets and market based solutions to problems. However, if we view health care as a national security issue and personal citizen responsibility (not necessarily a ‘right’ as some would argue) then it is fairly easy to justify some set controls on health insurance premiums and rates. At present, there is little control, and since product offerings vary so widely and offer insurers so many avenues to deny claims, theremust be some balance put into play.

(8) Eliminate state oversight of health insurers in terms of rates. Continued monitoring implementation of federal standards.

Again, not something that is offered lightly in view of this sites overall positive attitude to state (read local) versus federal controls. Nevertheless, the current set up creates a situation where health insurers can cherry pick not only those they will cover, but which states offer the most favorable climate for them (read profitability). States have a role to play as umpires but there must be a uniform playbook to govern all health insurers.

(9) As a regulated utility, the prices set should be wholly market based and not risk stratified for individuals or select groups

Basically, this is no different than offering any other product for sale. The price is not based on WHO is doing the buying, but based on the value of the product being offered as set by the overall buyers in the marketplace. By offering coverage to ALL individuals, the risk is shared and a proper premium structure, along with surcharges if needed, can be arrived at. The current system allows for some of this. However, all to often the result is denial of coverage from the get go or limitations on coverage, such as pre-existing condition exclusions. Also, we often see groups (such as women) adversely rated, forcing them to pay higher premiums based on their sex alone, not any other factor. This needs to be eliminated.

(10) Adoption of item 9 means pre-coverage physicals, pre-existing condition exemptions and the like will no longer be necessary – the premium is set and if I can afford it I buy it. I cannot be denied coverage for non-financial reasons. Companies will have to compete on efficiency of their systems and overall quality of their services.

As an outgrowth of item 9, this is perhaps among the most important of all tenants of this proposal. The major obstacles to health insurance access are limitations imposed by insurers on who they will cover and financial resources. The former can be EASILY remedied by adoption of national standards prohibiting discrimination in the purchase of health insurance. The latter can be dealt with through the current programs in place (as discussed above in item 4) as well as adjustments in the minimum wage and tax credits as needed.

(11) The base package of services required to be offered is pre set and supplements can be offered. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits. However, the base must be very broad to make sure the pricing factors in overall gross population risks, as opposed to sub group risks. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits.

What should be in the base package? First, all aspects of a major medical policy should be included. Second, emergent care. Third, preventative services (vaccinations, screenings, etc.). Fourth, basic materinty coverage for women and families. Deductibles can be varied to adjust price, as they are now, however, there should be limits on how high deductibles can be set for primary policies.

(12) Fine of $100,000 to any insurance company that denies writing the policy (basic) regardless of age, gender, sexual orientation, race, genetic assessment, pre-conditions, etc. Policies are not cancelable except by death or lack of financial qualification of coverage under item (1) above.

This site does not like onerous enforcement tools. Again, however, insurers need to know that there are penalties which will be applied if they discriminate against policy seekers for ANY reason other than inability to afford premiums. Individuals must be able to purchase coverage regardless of their health status which can and will vary from time to time.

(13) No limitation on sale of health insurance products across state lines. This means that consumers in all 50 states would be able to choose among all licensed plans sold in the United States.

This increase in choice and options will help insure competitive rates in the marketplace. The current system allows health insurers to cherry pick states and communities, with excessive rating of certain areas. By expanding to regional and national markets, health insurers can more easily spread their risk over the entire population insured.

(14) Hospitals and similar, fined $50,000 for refusing to treat presenting patients (patient non-compliance, refusal of treatment by patient, leaving against medical advice etc. would remain in force as currently practiced).

As noted in item 12, this site does not like onerous enforcement tools. Still, major health provider sites such as hospitals, emergency rooms and the like, must accept any patient presenting for care. Currently, all do, and there are federal laws in effect which govern much of their behavior in this area. However they are exposed both financially and legally in many cases by the current system. At this time, hospitals must treat individuals that present, regardless of insurance status or ability to pay. That means that emergency rooms are generally major financial losers for most institutions. The best way to overcome this is to increase the numbers of patients who have coverage via the mechanisms outlined above, so the current financial exposure is drastically reduced.

(15) Physicians and all other health care providers fined for refusal to treat $25,000 (dismissal of patients for non-compliance or other ethically accepted reasons as outlined by the professions would be maintained).

Again, as noted, it would be this site’s preference not to propose this. However, physicians and other individual providers must be willing to accept all patients who present to them for treatment. This is already the case for doctors who are on call for emergency room duty at hospitals nationwide. In the office or clinic setting this is also true, except that non emergent patients who lack coverage or ability to pay can be turned away. This proposal would not change that scenario for elective visits but would change it in fact since most if not all citizens would have health insurance coverage, which would make non coverage and / or non payment a non event.

(16) True tort reform will be instituted nationwide. Tort reform must include caps on damages for pain and suffering, but should still allow for medical cost recoup as well as any expected longer term medical costs to be recovered.

The current system encourages lawsuits. Additionally, lawyers almost always “blanket” sue, ensnaring anyone who was even remotely involved in the patients care or who is named in the medical record for any reason, even if they never care for or saw the patient. This creates a web of defensive medicine at every level in the system. Since this practice is systemic, it is very difficult to accurately gauge it in economic terms. However, the impact is large and accounts for billions of dollars of unnecessary tests and procedures annually. It also contributes to an endless stream of documentation as providers and facilities seek to justify every, single action taken in the care of patients. This time is wasted and better spent actually taking care of the ill.

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Teen says he's sorry about Florida boy's burning - CNN.com

Mickey — Wed, 25 Nov 2009 19:38:57 +0000

Teen says he’s sorry about Florida boy’s burning – CNN.com

Everyone's Talking About Stupak, But What About the Health Care Bill's More Insidious Features? | Reproductive Justice and Gender | AlterNet

Mickey — Wed, 25 Nov 2009 18:39:48 +0000

Everyone’s Talking About Stupak, But What About the Health Care Bill’s More Insid

Vendor Representatives in Clinical Areas - by Jerry Ippolito

seanesthesiology — Wed, 25 Nov 2009 16:32:46 +0000

Vendor Representatives in Clinical Areas – by Jerry Ippolito

In April 2009 the Joint Commission posted a response on its website to a question about standards that address vendor representatives in clinical areas. The commission says it does not have specific standards or credentialing requirements in this area because accepted national standards on competence for vendor reps are lacking.

The commission does note that some organizations are recommending general credentialing requirements for these individuals and refers to AdvaMed’s website (www.advamed.org).

The commission also cites several standards relevant to any person who enters a healthcare organization and affects the quality and safety of patient care.

More information at:

http://www.jointcommission.org/accreditationprograms/hospitals/standards/09_faqs/hr/hc_industry_vendor_representatives.htm

Southeast Anesthesiology Consultants provides you with the ability to staff your anesthesiology program, and can assist you in improving overall perioperative service efficiencies. By contracting with SAC, you can capitalize on our medical expertise to provide you program development, management, staffing and consulting in the following areas:
• Anesthesiology
• Pain Management
• Quality Initiatives
• Perioperative Services

Learn more about our services at www.seanesthesiology.com

Top Ten Ways for Pregnant Women to Enjoy Thanksgiving

drlindagalloway — Wed, 25 Nov 2009 15:49:08 +0000

Thanksgiving can be a time of reflection, family fun and unintended stress. Hopefully, all pregnant moms will spend the day relaxing while someone else plays chef, hostess and caregiver. However, if that is not an option, here are some useful tips that will help you enjoy the day to its fullest extent.

Try to cook dishes in advance to avoid standing on your feet all day. The pregnant uterus compresses the veins and prevents the return of blood back to the heart. This contributes to varicose veins and swollen ankles.
Watch the salt. Salt contains sodium that raises blood pressures and causes the body to hold onto to fluids, thereby causing swelling of the legs, ankles, hands and fingers.
Watch the fat, especially red meat and fried foods. The gallbladder processes fat in the body and, it doesn’t work as well. Pregnant women are at risk for developing gallstones.
As tempting as they might be, avoid overeating sweets. All pregnant women are screened at 28 weeks for Gestational Diabetes.
Avoid overeating. During pregnancy, the stomach gets compressed by the enlarged uterus. The stomach also empties food at a slower pace and the more food you eat, the longer it takes to digest. The stress of the body to digest a large portion of food could potentially cause preterm labor. Digestion of food is slower during pregnancy because of hormonal effects. Heartburn occurs in 50% of 3^rd trimester pregnant women.
Take a 30-minute walk either before the big meal or afterwards if possible.
Avoid lying down after eating a large meal because it causes heartburn that occurs in 50% of third-trimester pregnant women.
Avoid soda if possible because it can cause urinary tract infections.
Check out some food safety tips from CDC http://www.cdc.gov/Features/HolidayFoodSafety/
Relax and enjoy your sacred day.

Wishing all my readers a safe and joyous Thanksgiving!

MOM! YOU HAVE LIGHTS ON THE HOUSE?

mothermari — Wed, 25 Nov 2009 10:59:50 +0000

On Sunday the weather here in the Mid-west was gorges! I asked MacGyver to search for some white Christmas lights I thought were out in the garage. He uncovered several stands of lights that we had purchased for our tree that is in the front yard.

We bought an evergreen tree, which had a root ball so that we could transplant it in the yard to mark the first Christmas we spent in our new home, fourteen years ago. Now, the tree is so big you need a ladder truck to put lights on it, and since Mac is recovering from gallbladder surgery I was not going to be putting those up to this year, so I decided to string them around the front porch. Since he was good enough to dig them out, and it was so nice out.

Wow…the Sunday before Thanksgiving. This is a first! Yes, I’m the one who hates to see Christmas light out before THANKSGIVING, and can be very vocal about it! Which my son quickly reminded me of, when he saw the porch illuminated with the Christmas lights.

“Mom! You hate Christmas lights out this early! You have never done this! What is going on?” He said with a big grin on his face. To which I replied, “The porch light had burned out several months ago, and I keep forgetting to buy a new bulb, don’t need one now! It’s about be resourceful.”

Kids!

Hospitals and Healthcare Services

healthpa — Wed, 25 Nov 2009 10:43:42 +0000

There is not anything more upsetting than seeing a loved one or yourself facing a grim ailment. It is rightly said that ‘prevention is better than care’; so it is better that once you detect any symptom, consult your health personal assistant or your doctor. Get a health check up done often to stay healthy, as good health is the source of happiness. Every city houses several hospitals and you should know about the best Hospitals in your locality to get superlative healthcare services.

The best hospitals are the ones that are endowed with a rich history of successful treatment records and that which are equipped with all advanced facilities for maximum treatments including surgery. Treatments in India have gained much acclaim in the neighboring countries and patients visit the best hospitals to get treated. Whether it is complex heart surgeries or joint replacement or cancer treatment and related chronic ailments, healtchcare service providers have answers to every solution. There are a number of healtchcare service providers in India that provide online healthcare services facilitating the patient to fill all details online including seeking of an appointment before personally visiting the hospital. The hassle of staying in queue is thus negated!

Overloaded hospitals arouse Government concern

Viet Nam — Wed, 25 Nov 2009 04:17:42 +0000

Prime Minister Nguyen Tan Dung and relevant ministries held a working session with the Ministry of Health to address overcrowded hospitals while the State budget is limited.

Two patients stay in one bed in Thanh Nhan Hospital in Hanoi (Photo: VNA)

The Ministry of Health reported hospitals at the provincial and central levels have been running at 148.6 percent of their capacity, while those at the district level are 115.7 percent over capacity.

Vietnam has just 18 hospital beds for every 10,000 citizens against the world average of 25 beds, pointed out Health Minister Nguyen Quoc Trieu.

Sharing the ministry’s difficulties, Prime Minister Dung offered advanced disbursement of the 2010 and even 2011 budgets to those hospitals with approvable projects in order to put them into operation as soon as possible.

He also assured the ministry of a gradual increase in budget allocations to improve medical checks and healthcare for the poor and increase investment in infrastructure and technology.

Dung also called on the ministry to work closely with relevant ministries and agencies in disbursing Government bonds for hospitals at the district, provincial and central levels in order to make it an effective investment.

“Every effort should be made to catch up with the world average of 25 hospital beds for every 10,000 citizens in the next five years,” said the Government leader.

He also approved an initiative raised by the Ministry of Health to intensify investment into Hanoi, Ho Chi Minh City, the central cities of Da Nang and Hue of Thua Thien-Hue province and the southern city of Can Tho to raise them to the level of professional medical hubs.

Dung however called on the Ministry of Health to consider a project on financial mechanisms within this model in an effort to ensure reasonable charges but enough profit to encourage re-investment.

He also asked the ministry to submit a financial mechanism to the Government for approval which would encourage investments from all financial sources into healthcare.

“The Government may extend preferential loans to those investing in infrastructure and equipment so as to help build hi-tech healthcare centres and reduce the overload being experienced by hospitals,” he promised.

The Government leader also promoted the expansion of day-care hospitals and family doctors as a solution.

Source: SGGP Bookmark & Share

Great green gobs of...

annahell — Tue, 24 Nov 2009 23:35:10 +0000

Mood:	Healin’ up!
Music:	The Misadventures of Flapjack-“Whale Times”

So, I had my gall bladder removed on Friday the 13th.

See? I’m not making this stuff up, you guys. My life is as dramatic and exciting as my blog makes it out to be. Now if I could just figure out how to channel that excitement into more of a jet-setting, wealth-building, award-winning sort of direction.

I was going to do a giant, excruciatingly detailed, daily account of the preceding illness and subsequent surgery, but I don’t really have it in me anymore. Maybe it’s the pain pills talking? Maybe this is my body’s reaction to a new, gall free existence? Perhaps my “brush” with “death” has made me reorganize the priorities of my life/blog? Ah, so many questions…

Anyway, the short version is that I started getting really sick that Wednesday (Veteran’s Day). It felt like I had a bad stomach ache that wouldn’t go away and I was nauseous and feverish. I wasn’t feeling any better on Thursday and had developed a pain in the right side of my abdomen, just below my ribs. So, I made an appointment with my doctor.

The doctor told me there was something wrong with my gall bladder and that I needed to go to the emergency room to have an ultrasound. Wendy drove me to Rose Medical Center (wonderful hospital btw, everyone was super nice and professional) and I got an ultrasound, some excellent, intravenous pain medication, and admitted to the hospital just before midnight. I had surgery at noon the next day.

I was supposed to have a laparoscopic cholecystectomy, but the surgeon switched to an open cholecystectomy (meaning, they cut open my abdomen the old-fashioned way) when he discovered that my bladder de gall was gangrenous, full of stones, and falling apart. I stayed at the hospital for three more days and I’ve been home ever since.

I’m fine now, thanks for asking. I had my staples out last Friday and I feel about 75% of normal. But abdominal surgery isn’t something I recommend for, you know, kicks and stuff. I’m glad they were able to take out my accursed gall bladder without incident, but I’ll not darken their door again…if I can help it.

The doctor said I could go back to work this week, but I decided to take the rest of it off. We have a short work week due to the Thanksgiving holiday and I don’t feel great about a long commute in my delicate condition. So, I’ll be back to work on the 30th.

Wowser, that wasn’t shorter at all, sorry. So, what else is new? Um, my Mom and Aunt’s visit went really well. I have more to say about it, but I’m getting really sick of writing. Stay tuned. Also upcoming: a list of rock guys Wendy and I would totally do it with and how I started dating Lil John, sort of.

H1N1 in focus

clarionsafety — Tue, 24 Nov 2009 21:04:40 +0000

Attention to the H1N1 virus continues to increase. OSHA has issued what it called “commonsense fact sheets” that employers and workers can use to promote safety during the current H1N1 influenza outbreak.
See the news release here, and the fact sheets here.
There’s also the ubiquitous flu.gov, which is pretty comprehensive.
But things are far from unanimous on the safety and health front. The Pump Handle blog reports on disagreement, and a letter the American Public Health Association has written to the president regarding respirator use in health care facilities to protect workers. Three other leading health organizations had called for surgical masks to be allowed.

If you need safety signs or safety labels to outline precautions regarding H1N1, Clarion Safety Systems can rapidly customize them. Call us at 800.748.0241 for immediate help.

A Few Ideas for Reducing Costs

Health care -- how do we move forward — Tue, 24 Nov 2009 20:31:49 +0000

Editor’s note: Reducing cost in almost any area, gores someone’s ox. There are many studies that show if you do this or that, you can reduce health care by X. Of course the claims added together is greater than the sum of the current whole….sooo….here are a few examples of potential areas to investigate for savings or maybe not:
————-
A recent study estimates the percentage change in national health care spending that could be achieved if one of the following policies were implemented alone for 10 years:

A “bundled-payment” approach which provides a single payment for all services related to a given treatment or condition: 5.4% decrease
Bundling payments only for hospital-based services: 0.1% decrease
All-payer hospital rate setting: 2% decrease to a 0% increase
Adoption of Health Information Technology: 0.8% increase to 1.5% decrease
Disease-management programs: 1.0% increase to a 1.3% decrease
Medical Homes: 0.4% increase to 1.2% decrease

Source: “Controlling U.S. Health Care Spending — Separating Promising from Unpromising Approaches,” New England Journal of Medicine, November 11, 2009, http://healthcarereform.nejm.org/?p=2301&query=home

Surgeons' Mistakes Can Cost an Arm or a Leg

doctor2008 — Tue, 24 Nov 2009 17:10:10 +0000

A recent issue of the Annals of Surgery which studied the burn-out rates and the levels of stress in the US among 9000 surgeons revealed an additional interesting finding…9% of surgeons said they were concerned they had made a “major medical error” in the preceding three months.

The American College of Surgeons reported that one in ten surgeons admitted to a recent error in surgery

No matter how you look at it, these figures are alarming in today’s hospitals where patient safety is a top priority. Also, compared to physicians, errors made by surgeons have more severe consequences for patients due to the interventional (read – invasive) nature of surgical practice. The survey, commissioned by the American College of Surgeons, also showed that 40% were ‘burned out‘ and 30% showed symptoms of depression.

So how do you avoid mistakes when going for surgery ?

Some pointers include looking for a hospital with a good safety record as well as those possessing a recognised accreditation standard (such hospitals voluntarily undergo screening by a recognised review body, such as the JCI, in order to provide services of a certain minimum quality).

Find out from your doctor where he sends his relative to. What’s good enough for a doctor is usually a stamp of approval. Why, even nurses in the hospital may provide the right doctor if one cares to ask.

Look for someone who’s busy. Sure, it means long waiting times, but this might be worth it in the long run.

Finally, some health department websites do provide statistics on how many specific operations are done in a year and what the complication rates are. This way one can opt for the best hospitals for a particular procedure. This website provides info of the best hospitals in the US, for instance - click here.

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Drug-resistant bacteria on increase in U.S.: study-Reuters.

ramanan50 — Tue, 24 Nov 2009 16:05:56 +0000

Could this be the mutated Strains of known Bacteria whose growth /mutation may be attributed to indiscriminate use of Antibiotics?
WASHINGTON (Reuters) – Cases of a drug-resistant bacterial infection known as MRSA have risen by 90 percent since 1999, and they are increasingly being acquired outside hospitals, researchers reported on Tuesday.

They found two new strains of methicillin-resistant Staphylococcus aureus — MRSA for short — were circulating in patients and they are different from the strains normally seen in hospitals.

Ramanan Laxminarayan of Princeton University in New Jersey and colleagues studied data on lab tests from a national network of 300 microbiology laboratories in the United States for their study.

“We found during 1999-2006 that the percentage of S. aureus infections resistant to methicillin increased more than 90 percent, or 10 percent a year, in outpatients admitted to U.S. hospitals,” they wrote in a report published in the journal Emerging Infectious Diseases.

“This increase was caused almost entirely by community-acquired MRSA strains, which increased more than 33 percent annually.”

MRSA is now entrenched in U.S. hospitals. It was also known to be circulating in the community but it was not clear whether patients were carrying the infections out of hospitals, or the other way around.

Laxminarayan’s team found that many more people were being diagnosed with the community-acquired strains, and these strains were not replacing the known hospital strains. Instead, they are just adding to the overall number of MRSA cases.

“Our findings have implications for local and national policies aimed at containing and preventing MRSA,” they wrote.

For one thing, new, fast tests are needed so patients can be diagnosed and treated quickly. It is possible to treat MRSA but doctors need to know straight away so they start patients on the correct antibiotics.

“Lastly, infection control policies should take into account the role that outpatients likely play in the spread of MRSA and promote interventions that could prevent spread of MRSA from outpatient areas to inpatient areas,” they added.

MRSA is one of the most common causes of hospital-acquired infections. It can also now be picked up in schools, at fitness centers and elsewhere.

Symptoms range from abscesses to bloodborne infections that can kill quickly.

The researchers estimate that 20,000 people in the United States die each year from MRSA, and treating MRSA can range from $3,000 to more than $35,000 per case.
http://www.reuters.com/article/healthNews/idUSTRE5AN0N020091124

H1N1 Cases Declining In Hospitals Across US

w7075news — Tue, 24 Nov 2009 14:23:25 +0000

CDC reports number of H1N1 cases down in parts of US… From VOA. Full story

This site may contain information about: virus. The blog is also related to: virus.

Early detection decreases death rate from breast cancer

Obi Jo — Tue, 24 Nov 2009 08:37:46 +0000

The recent brouhaha created by the ill timed, ill worded, ill phrased (or is it just ill) report from the USPSTF (US Preventative Services Task Force) has stirred the pot to be sure. We support individualized treatment of patients. We applaud the tailoring of medical testing and procedures to individual needs and circumstances based on dialogue between patient and physician. The problem with these “task forces” and their pronouncements is that they color the insurance market and reimbursement policy. The rapidity with which Secretary Sebelius distanced herself, her department and the administration from these recommendations speaks volumes. This report is the proverbial hot potato and nobody in politically correct Washington DC wants to touch it. The sad part is that we know that early detection saves lives. The task forces concern for the ‘anxiety’ caused to women, was from our perspective, frankly, condescending, implying that women (females) may be too fraught with anxiety to deal with uncertainties regarding medical tests and their outcomes. This perspective, whether intentional or not, is balderdash (Colonel Potter’s favorite expletive on MASH). Arguments about mammography and its proper role are not new. We site several comments from various sources below on this vary issue. However, we continue to find any recommendation that suggests that physicians should limit physical examinations as an anathema. Also, suggesting that women, or patients in general, not be familiar with their own bodies is, in our belief, outside the mainstream of modern health thinking. Self examination is proper, useful and helpful to early detection. Proper physical examination by a physician or trained health professional is always appropriate. It would a shame to forgo the most respected and time tested traditions of medicine in a move to limit “anxiety” among patients. Anxiety is relieved by information. Making a diagnosis is never wrong. Patients can be counseled on options of treatment if and when a diagnosis is made. They can also be counseled on the options regarding diagnostic procedures. We believe, that in the end, doctors and their patients, together make the best decisions . . . obi jo and jomaxx

Between 1950 and the late 1980s, overall death rates from breast cancer were relatively stable, according to the ACS publication, Breast Cancer Facts & Figures 2001-2002. The death rates for breast cancer then began to fall, dropping by about 1.6% each year between 1989 and 1995. Between 1995 and 1998, the drop in the rates picked up speed, declining about 3.4% each year. Among the women screened with mammography during that time, deaths from breast cancer dropped by 63% compared to the 10 years before that when widespread mammography wasn’t available. Mammography makes such a large difference, notes Smith, because it can find tumors early when they are still small and more likely to be treated successfully. Smith says the present decline in breast cancer death rates can be expected to continue to accelerate, but only if mammography — and access to it — continue to improve. “There really is an enormous advantage to treating a tumor when it’s smaller,” notes Smith. “That’s really the bottom line.” …..

Breast Cancer Death Rates Continue to Decline: Mammography Is Key; Treatments and Awareness Credited, Too – http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Breast_Cancer_Death_Rates_Continue_to_Decline.asp

American Cancer Society recommendations for early breast cancer detection
- Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.

- Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have a breast exam by a health professional every year.

- Breast self exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

- Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%……

Can Breast Cancer Be Found Early? – http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?rnav=cri

Bernadine Healy, first woman to head the agency, said lives could be at risk. The fallout from last week’s controversial recommendation that women delay the start of routine mammogram testing for breast cancer continues, with a former head of the U.S. National Institutes of Health advising women to ignore the guidelines. “I’m saying very powerfully ignore them, because unequivocally this will increase the number of women dying of breast cancer,” said Dr. Bernadine Healy, who was nominated to head the federal agency in 1991 by then-President George H.W. Bush. “Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients,” said Healy, the first woman to lead the National Institutes of Health and currently the health editor at U.S. News & World Report. She made her comments Sunday during an appearance on the TV news program Fox News Sunday. The controversial recommendation, released by an independent panel, said that women don’t need to start undergoing mammograms until age 50, and then only need one every other year. Long-standing guidelines have said women should have annual mammograms after age 40. The independent panel, the U.S. Preventive Services Task Force, said its recommendation was based on the latest and most accurate studies. Many women immediately wondered if the guidelines would affect their insurance coverage for the breast cancer tests…..

Women Should Ignore New Mammogram Guideline, Ex-NIH Chief Says – http://health.usnews.com/articles/health/healthday/2009/11/23/women-should-ignore-new-mammogram-guideline-ex.html

There has been a longstanding debate over the most appropriate age to begin mammography screening and the frequency of screening examinations. As with all screening tests, the decision to perform a mammogram must include an evaluation of the benefits and the risks of the screening tool, as well as a consideration of patient preference. The recent controversy about mammography should not suggest that there is debate about the most important issues. Most breast cancer experts agree far more than they disagree. For example, there is no debate that mammography reduces the risk of dying from breast cancer. As stated in the new USPSTF recommendations, extensive scientific evidence demonstrates that mammography reduces breast cancer mortality both among women aged 50 and older, as well as among women aged 40 to 49……

Susan G. Komen for the Cure® Scientific Advisory Board’s Perspective on the U.S. Preventive Services Task Force (USPSTF) Recommendations on Breast Screening – http://ww5.komen.org/ContentSimpleLeft.aspx?id=6442451488

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When Medical Results Get Switched?

Nemcy — Tue, 24 Nov 2009 06:58:07 +0000

After a few weeks of cleaning from the wreckage typhoon Ondoy has given us, physical pain on the lower back troubled Nanay (my mother). At first, she can tolerate and endure the pain. Thinking that it could be just a minor muscle pain from all the walks and cleanings she did, it would just go away when she give it a rest or a few rubs of liniment. Sad to say, just a couple of weeks ago, she decided to go to a doctor for a checkup. We feared that her kidney stones could have returned again but after a few more tests, her kidney is cleared BUT when the Xray results came in a bone somewhere near her pelvic area was sort of mislocated.

My mom has Scoliosis for the record. It’s pretty obvious recently because her right should blade seems to be bulging out more through out the years. She not much of a milk or dairy fan. Then after the doctor explained to her the result. She admitted that she did carry some stuff during the cleanign period that could have caused the bone misalignment/damage.

My mom is 69 years old. Doctor’s advice, look for a hospital that do Bone Densitometry.

Thanks to technology (Google to be exact) I was able to locate a hospital (Delos Santos Medical Hospital) that provides that service. Called them up, asked for details and the fee for the service. True enough, this hospital was mentioned not to charge that much for hospital and medical services compared to other private hospitals. I’m glad that they provide these kinds of services but I have a little bit of doubt since I heard before that in this hospital happened a baby switching mishap. But I was also advised that it has teamed up with STI school which provides some “new” technology approach for the hospital, so I guess it’s worth a try since it’s near and accessible since my mom will be coming from our province. Last week my mom went there to have the service and was asked to come back a couple of days after to get the result.

Come weekend, my usual schedule to go home to the province to rest and be with my parents. My mom showed to me that the last page of her bone densitometry test was not hers. Well, true enough it’s not her because it’s not her name nor her other details (like age, weight, date of test and physician’s name) but they both have the same surname that might have been the cause of confusion.

So just this morning, I called up the hospital to ask what happened. The moment I mentioned that there’s a mistake on the results released, the woman on the other line seemed mum for a few seconds before she asked for the details. They told me to come back and get the results but it’s a hassle for me or my mom. I told them can they just email it since the results were “computerized” (though my friend said I should demanded that they send a copy via courier). They said they’d come back to be within the day and gave them my mobile number.

I was giving myself until 3PM today before I call up again. But just a few minutes ago, they called up and explained that the 3rd and last page is not part of the indicated test results on the first page. They just took a photo of my mom’s spine from the side, no readings from it. It gave me the impression that it’s not needed but for my peace of mind I asked that they provide my mom’s file (of course we would like to have a file of it with my mother’s name and details on that sheet of paper). Within 30 minutes they emailed me copy.

I’m not bad-mouthing the hospital. In fact I’m kind of glad they expanded their services and fees are not that jacked up compared to other private hospitals. I admit too that we have our faults as well so here are the lessons learned that I hope you guys will take considerations also:

1) As much as you can, do accompany your friend, family member or relative specially if you know they are a bit on the senior age. I admit that I am at fault that I didn’t go with my mom. But I heard my brother was with her when she got the result. I believe being with someone when you go to hospitals or do medical checkups somehow helps ease the “tensions” or even mistakes like this. It’s also good to know what’s happening, what’s the test is all about and what is the result. Honestly, my mom is quite annoyed at me when I asked her what the doctor said. She could explained it to me… but I guess I’ll be forgiven (somehow) when she hears that I got the switched result.

2) Check the results. Double check (triple if you like). Though we non-medical practitioners may not understand what it says on the results, at least we know how to read. We know our name (or the name of the person you are accompanying) and other details. In this way, you can avoid much hassles like going back and taking the waiting queue again. Less hassle and time wasted. Because of what happened my mom had to wait a day or 2 for her back and waist/hip brace to be done/measured.

3) Be nice to others and communicate with courtesy. Well, if anyone from the said hospital is reading this blog entry, sorry if I raised my voice a bit though at times it works when you raise voice to get their attention but I still prefer 9and it’s really BETTER) talking and explaining in a modulated way. I have to admit if my personal deadline (the 3PM mentioned above) did come, well, let’s leave it to your imagination But kudos to the medical staff (Mylene or was it Michelle?) who called me up, explained and responded to my request. I consider that a fast action. I just hope your hospital won’t commit another mishap (may it be like this or the baby switching insident).

If I’m asked if we’ll take medical services in the same hospital again, yes, why not. They corrected their mistake and so far the result is accurate. I’m pleased they responded immediately.

Not my mom's spine but the REAL image (in bone densitometry test) is sort of like this

Public Health Versus Private Health: The Coming Battle: 1. The Difference Has Little to do With Government and the Private Sector.

Scriptamus — Mon, 23 Nov 2009 21:35:44 +0000

Former Surgeon General C. Everett Koop Written by Lewis D. Eigen Public health workers are generally

Alternatives to the medical checklist?

nudgeblog — Mon, 23 Nov 2009 21:18:54 +0000

In Maryland, state leaders recently kicked off a program that will send 45 teams of observers to 47 hospitals to record the hand-washing habits of doctors and nurses. Governing Magazine calls the teams, spies. They have to be anonymous in order to alleviate the potential Hawthorne effect.

So far, the medical checklist is the most successful and best known nudge for improving hand-washing habits in hospitals, but the program’s FAQ makes clear it is open to other strategies that include “campaign branding, addition of new members to the multidisciplinary HH (hand hygiene) team, hand hygiene education, signage, environmental enhancements, improved reporting process, new tool development, enhanced communications concerning HH, and others.”

Electronic Medical Records Isn't Cheaper Or Better, No Kidding.

mcnorman — Mon, 23 Nov 2009 19:39:44 +0000

Computers Aren’t Saving Hospitals Money. The report’s lead author, Dr. David Himmelstein, associate

Hospital Readmission Rates

Health care -- how do we move forward — Mon, 23 Nov 2009 19:13:24 +0000

Editor’s note: It would be interesting to understand what the Lean Six Sigma ‘Entitlement’ rate is for 30-day all cause hospital readmisstion rates are for Medicare patients. In otherwords, what is the best that another comparable hospital has attained on this measure.

The unadjusted 30-day all-cause hospital readmission rates for Medicare patients discharged after heart failure were: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006.

Source: “Recent National Trends in Readmission Rates after Heart Failure Hospitalization”, Circulation: Heart Failure, abstract only, November 10, 2009,http://circheartfailure.ahajournals.org/cgi/content/abstract/CIRCHEARTFAILURE.109.885210v1